OBJECTIVE

• Sr.Business Analyst with wide body of experience in varied lines of business across in the managed healthcare field, to include Medicaid and EDI.
• Experience training staff on a wide variety of software and computer systems including client - server and mainframe. Reporting experience.
• Experience in leading projects and coordinating upgrades of software.

SUMMARY

• Over Eight years of experience in the IT industry specializing in Business Analysis.
• Sound knowledge of the Software Development Life Cycle.
• Experience in health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDI and XML
• Good understanding of Medical Claim processing, Health Care plans, HIPAA, Facets, PPO, COPAY, Retails.
• Excellent Experience in SDLC Methodologies like RUP, Agile/Scrum and waterfall
• Liaison between business stakeholders and technical teams to ensure proper translation of Business Requirements to System Requirements.
• Excellent time management skills with the ability to prioritize critical and non-critical duties.
• Motivated self-starter with exceptional team building, Leadership, and interpersonal skills.
• Highly analytical in developing the methods and measures to meet requirements and solve any issues that arise during the project.
• Experienced with various Business Analysis SDLC Methodologies, such as RAD, RUP, JAD, and Spiral Methodologies.
• Extensive experience in Pharmaceuticals, Health Care: Membership, Pharmacy Benefit Management (PBM), Claim, Pricing, Commission.
• Designed Use Cases, Activity Diagrams, Sequence Diagrams, and Class Diagrams, Data flow Diagrams by using MS Visio.
• Performed AS-IS Study of the system and TO-BE Analysis, revision of Business Process Procedures to in corporate necessary changes.
• Performed gap anlaysis.
• Extensive use of UML/RUP for modeling views in Microsoft Visio, Excellent analytical skills.
• Strong healthcare and Medicaid business configuration experience with focused primarily on claims adjudication, pricing, provider, member, enrollment, prior authorization
• Expertise in Project Planning, Project Design, Gathering requirements, creating Functional Specifications, and Data Flow Diagrams.
• Experience in conducting/facilitating Focus Groups Sessions, Stakeholder Interviews, Joint Application Development (JAD) and Joint Requirement Planning (JRP) Sessions for effective requirement gathering.
• Experience in creating documents such as Feasibility Reports, Systems Request, and Risk Assessments.
• Experience in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall
• Establish documentation for agile methodology for implementation with a very water-fall-centric development team.
• Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
• Experience in assisting Project Managers in creating Cost/Benefit Analysis Reports.
• Involved in preparation of Cost proposals to perform projects.
• Experience in customer / client interaction, on a regular basis.
• Involved in maintaining Requirements Traceability Matrix.
• Good knowledge of System Testing, Integration Testing
• Experience in writing SQL queries to generate reports.
• Excellent Documentation skills to ensure proper communication channels between Business sponsors and technical teams during the entire software development process.

TECHNICAL SKILLS

Tools: Experience: Test Director, JIRA, Rational Clear Quest, Quality Center, MS VISIO, SQL Developer, Toad, Agile

Testing Software: QTP, Test Director, Win Runner

Bug Reporting Tools: Test Director

Operating Systems: Windows Server, Windows, LINUX and UNIX.

Programming Languages: SQL, UML, JAVA, .Net, RUP, Agile

PROFESSIONAL EXPERIENCE

Confidential, MA

Sr.Business System Analyst

Responsibilities:

• Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the User story and defining data requests and requirement for the DQ enterprises
• Involved in daily standard meeting to discuss any roadblocks or impediments in the project path.
• Support IT goals and objectives by working closely with internal Scrum team members and Stakeholders to ensure that integrations and implementations exceed Client expectations.
• Work within a distributed team to document, prioritize, develop, test and release small to large scale EDI solutions with Clients located across the country
• Created Use Cases that defined the role of users who receive claims, users who process claims, and users who adjudicate claims.
• Dental Claims experience in Process Documentation, Analysis and Implementation with a significant focus on dental encounters, claims, eligibility and enrollment via 837, 835, 999, 834, 277 EDI standards
• Used MS Visio to develop UML diagrams.
• Document and maintain requirements using source to target maps, data dictionary, process documentation and team defined standards; using tools such as Visio, Word and Excel.
• Supports in user acceptance testing and coordination of implementations
• Conducted interviews with theBusiness Users for requirement elicitation and gathering, interviewed SMEs(Subject Matter Experts)and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Ensure data quality through scenario based testing
• Work with IT and business users to evaluate data and extract requests and recommend viable short and long term solutions
• Analyzed data and created reports using SQL queries for all issued Action Items.
• Identify sources of requirements, possible interfaces and affected lines of business.
• Gain an understanding of the stakeholder's business culture and priorities, the need for different modeling techniques used when gathering requirements, the corporate standards for documentation, methods for prioritizing requirements and tools for tracking requirements.
• Assisted in Regression Test, System Test, and UAT.
• Proficient in all areas of requirements elicitation (facilitation, process modeling, requirements documentation).
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements.
• Work with developers and business representatives in the resolution of testing incidents
• Responsible for communicating status, issues and risks to management and the relevant project teams
• Responsible for tracking and escalating incomplete issues to closure
• Develops implementation plans, training plans and user documentation as needed
• Generating Weely accomplishments Team report
• Worked on Production Issue

Environment: MS Visio, Microsoft SQL Server, Quality Center, IBM DB2, MS Word and MS Excel, Microsoft SharePoint, Sales Force, .NET, Windward, Agile Methodology, TFS, Outlook, MS Team, FTP, MS Project

Confidential, MI

Sr.Business Data Analyst

Responsibilities:

• Worked as a Business data Analyst and Act as a liaison between the business units, QA and the technology teams
• Enhanced the Medicaidencounter(837) and enrollment (834) companion guides, enhanced requirements, co-authoredtest plan, and developed test data via SQL and manual editing (ETL).
• Gathered business requirements through discussion with stakeholders and SME’s.
• Involved in activities to make sure proper documentation and standards are being followed.
• Wrote Business Requirement Document after collecting requirements through conducting interviews, JAD Sessions and brain storming sessions.
• Worked on data modeling and produced data mapping and data definition documentation
• Developed use case Designed process flow diagrams using MS-Visio and Business Context Diagrams.
• Worked extensively on EDI transactions 837 and 835 Involved in writing test cases for different LOB’s (ITS, FEP And Regular) for SIT, Parallel and UAT.
• Created the logic for flat files and 837I, 837D, 837P according to business requirements and documented in FRD.
• Created business process mapping document, analyzed the as-is business processes and created a to-be process using MS Visio.
• Validated that the 270/271 generated is in accordance with the 5010-implementation guide.
• Assisted in managing and billing Medicare, Commercial HMO/PPO claims daily.
• Worked on data modeling and produced data mapping and data definition documentation
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the database tables.
• Created Data Mapping document between legacy & new application as per business user requests.
• Prepared test Data sets and performed data testing and used MS excel for data mining, data cleansing, data mapping,data dictionary and data analysis.
• Documented data content, data relationships and structure, and processes the data usingInformaticaPower
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Re-engineered and captured EDI transactions with legacy systems Enrollment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
• Validated and ran numerous SSIS packages and SQL scripts according to the operation’s ICD.
• Extracted, generated and troubleshoot 820s DHS (remit advices) files which are out of balance and once they passed validations they were sent to the bank for distribution to the issuers.
• Involved in writing complex SQL queries to check the data integrity.
• Involved in the complete business process redesign and reengineering effort in converting existing process into a strategic web-based environment..
• Perform file and data analysis for Health Plan enrollment data files to identify issues with data quality throughout the ETL process and to inform improvement to data quality processe
• Troubleshooting report queries by reviewing report calculations, parameters and underlying data, and explaining what the reporting fields are showing.
• Prepared test Data sets and performed data testing using the SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.
• Developed reports using SQL in MS SQL Server environment
• Provide support to end users while execution of UAT with proper test scenarios & test data.
• Managed requirements, bugs and issues using Jira and tracked the project life cycle.
• Monitored RTM to close the defects/cases as and when developers resolved the defects
• Communicated with developers and Business Analysts through all phases of testing to prioritize defect resolution.
• Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards
• Created UML Diagrams like Sequence Diagrams, Activity Diagrams and process flow diagrams to elaborate the new processes using Rational Rose and MS Visio.
• Maintaining requirements/business rules forEnterprise Data Warehouse, Business Intelligence Tools.
• Actively involved in weekly walkthrough meetings and Daily Defect calls to verify the status of the testing efforts meeting the deadlines & mid-term targets.

Environment: MS Visio, Microsoft SQL Server, Quality Center, IBM DB2, MSWord and MS Excel, DBweaver, PWC, Microsoft CRM, Microsoft SharePoint.

Confidential, CA

Sr.Business Analyst

Responsibilities:

• Worked as a Solo Business Analyst and Act as a liaison between the business units, QA and the technology teams. Lead JAD sessions and act as the lead facilitator for various projects from start to finish through the SDLC.
• Participate in Code Reviews, System Testing and UAT followed by production verification, post production testing and support.
• Conducted BRD walk thru session with the entire team, business, testers and developers after the completion of the BRD. Organize meetings with the SMEs of the dependent systems. Conduct weekly issue meetings with customers.
• Worked closely with state reporting program manager and director of state reporting.
• Created report mock-up to review the requirement and provide feedback on the report design and Microsoft paint, to create ad-hoc screen mock-up to review with the users.
• Responsible for Data Manipulation and Data Validation using SQL queries in a MS SQL Server environment.
• Prepared Business Required Document (BRD), Functional Specification Documents (FSD), and got sign off to be used by thedevelopers and clients.
• Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using Unified Modeling Language (UML), and with Rational Rose.
• Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.
• Helps in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis.
• Performed GAP analysis of business rules, business and system flows, user administration and requirements
• Created prototypes of the GUI environment using iRise to be used by the developers during the design phase
• Developed detail class diagrams and sequence diagrams using Rational Rose.
• Developed as-is and to-be business processes using BPMN standards.
• Identified and establish scope and parameters of requirements analysis in order to define impact, outcome criteria, and measure- taking actions through interface analysis, prototyping and JRP/JAD session with focus group.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence SSRS
• Documented business requirements for system issues and enhancements using Rational Requisite pro.
• Traced requirements by Business intelligence (BI) tools, to high-level design, test cases and product requirements and Created the End-User Documentation.
• Worked with the development team during the Design, Build and Test phase of system projects to clarify business requirements asrequired.
• Worked closely with Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications
• Used SharePoint to manage schedules, deadlines and resources and collaborate on the project.
• Provided post production support/analysis and assisted in performing User Acceptance Testing (UAT), performance testing and validated test plans.
• Working on the production issues via Microsoft CRM.
• Used Team Foundation Server (TFS) for tasking and monitoring the progress of the task assigned.

Environment: Agile Methodology,Version One, Rational Clear Quest, SQL, Microsoft CRM, Quality Center, UML, MS Visio,MS Word, UML, Quality Center, FTP, Microsoft SharePoint,TFS, Microsoft SQL, MS Visio, XML/XSLT, JavaScript, MS Project, Power Point, IBM Web Sphere, MS Outlook, Window, BI Tools SSAS,SSIS

Confidential, CA

Business Analyst/Quality Analyst

Responsibilities:

• Worked as the business analyst for IT department to perform analysis and provide recommendations on all internal IT project requests.
• Creating comprehensive research of all technical and non-technical processes affected by the system migration.
• Designed and developed Project document templates based on AGILE methodology
• Responsible for Gathering, Developing and Documenting Systems Requirements Documents, Functional Requirements Specification documents, Use cases, User stories, workflow/process diagrams, data flow /data model diagrams documents.
• Elicited and gathered user and business requirements through open ended discussions, brainstorming and prototyping,
• Participated in the bug review meetings and provided clarity on issues.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Created queries and pulled data into SQL 2012 and MS Excel 2012 for analysis and reporting
• Worked in mainframe environment and used SQL to query various reporting databases.
• Responsible for gathering requirements, creating artifacts for Rational Unified Process (RUP) - use cases, system architecture document, supplemental requirements document, architecture diagrams; verifying technical production infrastructure; designing and executing performance tests; and documentation.
• Formulated functional specifications based on System requirements, inclusive of a logical data dictionary, future-state use case documentation, wire-frames, and data conversion/mapping specifications. Authored Use cases, System Requirement Documentation (SRD), and System Requirement Change Request. Analyzed, Evaluated and assessed gaps in the current processes.
• Analyzed and optimized the process, prepared Business Requirements Document, and then converted business requirements into Functional Requirements Specification and Technical Specification. Conducted JAD sessions for communicating with the all project directors and stakeholders and created process workflows, functional specifications and project initiation artifacts, Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Mappedtest cases from Excel toSQLby using Data Transformation Services.
• Conducted the requirements and design walkthroughs with designers, developers, and management staff, created a test approach document that was used as a high level document on which the test cases were based.
• Testing and Preparing test scenarios. Prepared the test plan, scope and other relevant documents, reviewing, and testing the test cases.
• Creating Change Request Document and QA log items in TFS
• Analyzing the change request and coordinating the changes required with the development team.

Environment: Agile Methodology,Version One, Rational Clear Quest, SQL, Quality Center, UML, MS Visio,MS Word, MS Excel UML, Quality Center, FTP, TFS, Microsoft SQL, XML/XSLT, JavaScript, MS Project, Power Point, MS Outlook, Window,SSIS, SSRS.

Confidential, MAHWAH, NJ

Business Analyst

Responsibilities:

• Prepared Business Scenarios document bases on Functional Requirements.
• Involved in the analysis of the existing credit card processing system, mapping phase according to functionality and data conversion procedure.
• Designed functional specifications for customization of credit card functionality in Accounts Receivables
• Involved in a migration and conversion project for Credit card services.
• Responsible for Vision and business requirements for credit card payment processing application
• Supported great data analyst operation in performing complex queries and operation by implementingData warehouse methods.
• Facilitated collection of functional requirements from system users and preparation of Business Requirement documents that provided appropriate scope of work for technical team to develop prototype and overall system.
• Facilitated JAD sessions with end users, development and QA teams.
• Authored Business Requirements Document BRD with project teams. Extracted, discussed, and refined business requirements from business users and SME’s.
• Create technical design documentation for the data modeling and data mapping
• Prepared Use cases and Activity flow diagrams and Work flow diagrams, considering the scope of the project with MS VISIO 2003.
• Wrote SQL commands to access the databases and to test functionality of the application.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Moreover, I also authored functional requirements documents FRD by interacting with development team for improving client’s legacy system.
• Designed and developed project document templates based on SDLC methodology
• Prepared Use Case Diagrams.
• Developed the wireframe and mockups for the prototype of the web based portal application in MS Visio
• Analyzed the system specifications, business requirements for full understanding of the project and created Business System Analyst Reports.
• Managed project resource allocations, planning and status updates to ensure efficient and responsive operations along with senior management.
• Participated in Project Iteration design meetings to discuss project status and resolve issues.
• Participated in entering and tracking system defects in Rational ClearQuest.
• Assisted to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and product knowledge.

Confidential, Middletown, NY

Sr. Business Analyst

Responsibilities:

• Responsible for interacting with client for requirements gathering, analyzing requirements, and creating detailed specifications.
• Engaged in analyzing requirements, identifying various individual logical components, expressing the system design through UML diagrams.
• Facilitated group discussions to elicit requirements in Joint Application Design (JAD) sessions by communicating with internal users and stakeholders, documented scope definition, functional specifications and created User Interface prototypes.
• Prepare new policies and process with efficiencies for managed care department.
• Negotiate with the Pharmacy Benefit Management (PBM) in regards to discrepancies and associated financial recoverable.
• Worked in close collaboration with the Project Manager andbusinessusers to gather, analyze and document the functional requirements for the project.
• Prepared functional requirements and non-functional requirements based upon the approvedbusinessrequirements by following UML processes and standard procedures for developing use cases, use case diagrams, and other supporting documentation.
• Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager.
• Observed the compliance of the requirements with federal and state government regulations Medicaid, Medicare, and accreditation body requirements.
• Responsible for Managing and growing Managed Care Revenues. Develop and expand payor panels for assigned territory.
• Traced requirements by Business intelligence (BI) tools, to high-level design, test cases and product requirements and
• Created the End-User Documentation.
• Actively participated in status report meetings & interacted with developers to discuss technical issues.
• Designed, test, and customized Electronic Medical Record (EMR) templates, documents and crystal reports compliant processes like HIPAA (4010)/ EDI formats and accredited standards like ANSI.
• Developed and executed SQL queries on claim records to validate reporting.
• Assisted client in developing content and training materials; recommended enhancements and identified new business requirements ensuring appropriate documentation.
• Present value-added service presentations to current and prospective payors.
• Maintain knowledge of current market trends and information in the marketplace and managed healthcare system as it pertains to Confidential .
• Responsible for addressing, diagnosing, and resolving issues that arise on a day to day basis for the team and also responsible for documenting the causes, analysis and final resolution to the issues.
• Worked effectively with physicians, nurses, and engineers to solve problems related to EMR, EPM, and ICS to make software more user-friendly to staff and doctor.
• Provided status report to Project Manager and assisted with monitoring the timely completion of scheduled tasks and escalating risks across the project lifecycle.

Environment: Windows, UML, Use Case diagrams, Rational Rose, MS Visio, MS Project, SQL Server, RUP, HTML, Test Director